B26 (Official Form 26) (12/08) United States Bankruptcy Court __________________ District of _____________ In re Debtor , Case No. ____________________ Chapter 11 PERIODIC REPORT REGARDING VALUE, OPERATIONS AND PROFITABILITY OF ENTITIES IN WHICH THE ESTATE OF [NAME OF DEBTOR] HOLDS A SUBSTANTIAL OR CONTROLLING INTEREST This is the report as of __________on the value, operations and profitability of those entities in which the estate holds a substantial or controlling interest, as required by Bankruptcy Rule 2015.3. The estate of [Name of Debtor] holds a substantial or controlling interest in the following entities: Name of Entity Interest of the Estate Tab # This periodic report (the "Periodic Report") contains separate reports ("Entity Reports") on the value, operations, and profitability of each entity listed above. Each Entity Report shall consist of three exhibits. Exhibit A contains a valuation estimate for the entity as of a date not more than two years prior to the date of this report. It also contains a description of the valuation method used. Exhibit B contains a balance sheet, a statement of income (loss), a statement of cash flows, and a statement of changes in shareholders' or partners' equity (deficit) for the period covered by the Entity Report, along with summarized footnotes. Exhibit C contains a description of the entity's business operations. THIS REPORT MUST BE SIGNED BY A REPRESENTATIVE OF THE TRUSTEE OR DEBTOR IN POSSESSION. The undersigned, having reviewed the above listing of entities in which the estate of [Debtor] holds a substantial or controlling interest, and being familiar with the Debtor's financial affairs, verifies under the penalty of perjury that the listing is complete, accurate and truthful to the best of his/her knowledge. American LegalNet, Inc. www.FormsWorkflow.com B26 (Official Form 26) (12/08) ­ Cont. Date: ___________ _____________________________________ Signature of Authorized Individual _____________________________________ Name of Authorized Individual _____________________________________ Title of Authorized Individual 2 [If the Debtor is an individual or in a joint case] Signature(s) of Debtor(s) (Individual/Joint) _____________________________________ Signature of Debtor _____________________________________ Signature of Joint Debtor American LegalNet, Inc. www.FormsWorkflow.com B26 (Official Form 26) (12/08) ­ Cont. Exhibit A Valuation Estimate for [Name of Entity] 3 [Provide a statement of the entity's value and the value of the estate's interest in the entity, including a description of the basis for the valuation, the date of the valuation and the valuation method used. This valuation must be no more than two years old. Indicate the source of this information.] American LegalNet, Inc. www.FormsWorkflow.com B26 (Official Form 26) (12/08) ­ Cont. Exhibit B Financial Statements for [Insert Name of Entity] 4 American LegalNet, Inc. www.FormsWorkflow.com B26 (Official Form 26) (12/08) ­ Cont. Exhibit B-1 Balance Sheet for [Name of Entity] As of [date] 5 [Provide a balance sheet dated as of the end of the most recent six-month period of the current fiscal year and as of the end of the preceding fiscal year. Indicate the source of this information.] American LegalNet, Inc. www.FormsWorkflow.com B26 (Official Form 26) (12/08) ­ Cont. Exhibit B-2 Statement of Income (Loss) for [Name of Entity] Period ending [date] [Provide a statement of income (loss) for the following periods: 6 (i) For the initial report: a. the period between the end of the preceding fiscal year and the end of the most recent six-month period of the current fiscal year; and b. the prior fiscal year. (ii) For subsequent reports, since the closing date of the last report. Indicate the source of this information.] American LegalNet, Inc. www.FormsWorkflow.com B26 (Official Form 26) (12/08) ­ Cont. Exhibit B-3 Statement of Cash Flows for [Name of Entity] For the period ending [date] 7 [Provide a statement of changes in cash flows for the following periods: (i) For the initial report: a. the period between the end of the preceding fiscal year and the end of the most recent six-month period of the current fiscal year; and b. the prior fiscal year. (ii) For subsequent reports, since the closing date of the last report. Indicate the source of this information.] American LegalNet, Inc. www.FormsWorkflow.com B26 (Official Form 26) (12/08) ­ Cont. Exhibit B-4 Statement of Changes in Shareholders'/Partners' Equity (Deficit) for [Name of Entity] period ending [date] 8 [Provide a statement of changes in shareholders'/partners equity (deficit) for the following periods: (i) For the initial report: a. the period between the end of the preceding fiscal year and the end of the most recent six-month period of the current fiscal year; and b. the prior fiscal year. (ii) For subsequent reports, since the closing date of the last report. Indicate the source of this information.] American LegalNet, Inc. www.FormsWorkflow.com B26 (Official Form 26) (12/08) ­ Cont. Exhibit C Description of Operations for [name of entity] [Describe the nature and extent of the estate's interest in the entity. Describe the business conducted and intended to be conducted by the entity, focusing on the entity's dominant business segment(s). Indicate the source of this information.] 9 American LegalNet, Inc. www.FormsWorkflow.com